Trouble Up North Woe Canada: Government-run medicine has proved a failure there, but the establishment thinks a dose of U.S. money can save it.

November 19, 1995|By Susan Riggs

IN THE SPRING OF 1993, the United States prepared to spring into action on the most important debate of its collective life -- government-run medicine. At that time, another discussion was under way in Canada, one that involved Americans and their medical care. It was a quietly conceived Canadian plan that could have changed -- and still might change -- the face of American health care forever.

A plan was formulated by Canadian hospitals, in tandem with the Ontario government, to formally attract U.S. patients to Canada. The idea was not new: Over the course of 1990-91, $33 million had flowed into Ontario coffers from the treatment of U.S. patients. Now, the plan was to formalize this transfer of Americans into Canada. As one Canadian hospital administrator commented, Americans would soon be "rolling through the operating doors." The move appeared logical. For years, the Canadian government-run medical system sent (and continues to send) some of its citizens to the United States for treatment. The reasons are straightforward: Government-run medicine has created a crisis of funding in Canada. So, the rationale goes, why not turn that crisis into a solution by using government funding to undercut private enterprise in the United States?

Why would the United States, with its abundance of technology, be persuaded to such a scheme? Cost. Canada can provide medicine that falls below U.S. prices but above Canadian ones. Such a plan would appear to benefit everyone: An influx of U.S. cash would enable Canada to buy more technology and help prop up a flagging health care system. U.S. citizens would pay less for health care.

As a Canadian living in Canada, I invite you to consider the implications of such a plan for your country. Would such a "solution" prove to be a win/win scenario? Or is it a classic case of pouring the new wine of American free enterprise into the old and broken flask of socialized medicine?

While health care providers are still debating whether the U.S. and Canadian systems are compatible, maybe we all should be asking if they are comparable in the delivery of quality health care.

I realize that your country is grappling with huge medical costs and problems of accessibility. What inhibits the growth of medical accidents in your country, however, are market forces that encourage accountability and a justice system oriented toward carrying out the will of the individual rather than the collective.

Such forces are not a part of the Canadian system. If you traveled to Canada right now, you would read of the medical horror stories that dominate our newspapers: A woman enters the hospital for simple gall bladder surgery. She leaves the operation with a slit bile duct and blood vessel, half her liver dead and 9 surgical clamps left inside her body. Canadian patients wait months in line for medical treatment only to get to the head of the line and discover that the aging equipment has broken down. Canadian shortages now include doctors. Over the past several years, top-notch Canadian physicians exited in droves to the United States. Financial incentive? Maybe. Or maybe there are other reasons -- such as the anguish many fine physicians must feel when they read surveys that show a substantial number of their colleagues prescribing excessive narcotics to seniors, failing to monitor patients with diabetes, high blood pressure and thyroid disease and failing to follow up on abnormal lab results.

The trouble with blood

Arguably, with enough financial incentive, the Canadian system might improve. Unfortunately, what will not change are problems bred into the bones of a government collective. One such problem is the nation's blood supply.

In September of 1994, the U.S. government banned Canadian blood products. Specifically, it found 19 safety infractions at one Toronto blood plant. Several of Canada's 17 blood centers also failed U.S. safety regulations.

The ban was particularly unsettling because the United States granted a favor to Canada by allowing the blood to cross the border in the first place. Ten years ago, the United States suspended normal licensing requirements to allow Canadian blood to travel to a fractionation plant in North Carolina where blood products (such as clotting substances for hemophiliacs) are made. Having no plant of its own, Canada ran the risk of a blood shortage. The deal was struck on condition that Canada would ship only "recovered" plasma (whole blood which has been processed to remove the plasma) rather than "source" plasma (extracted directly from one donor). When the U.S. government examined the Canadian blood plants in the summer of 1994, it discovered that source plasma was being shipped along with recovered -- an act that contravened the original agreement. Canada was told it must cease shipment of all source plasma and meet safety requirements for the other.